How do you move someone to a memory care unit when they are completely resistant and no therapeutic lie will work?

My relative was eating poorly & I suspected overusing pain relief for a short time too. Hygiene often lacking. Home carer aides collected whatever groceries she chose & any OTC pain relief she ordered. They seemed to make good suggestions for healthier diet, exercise, hygiene etc but altimately it was her house, her wishes.

But in facility care (short term) what a change! She walked more as encouraged by the others, ate fruit & vegetables & enjoyed the meals! No pain reported & showered everyday.

The illnesses that cause the lack of insight are still there. I'm not sure why she changed in care - more staff? Power of a peer group? I have been told by her Doctor, if/when the balance tips too far into self-neglect - involuntary admission, guardianship application & facility care would be the next steps.

Sadly some people will not improve in care - prefering their own room to any company & staying depressed. Parkinson's has physical & mental problems - I believe depression is common. Dementia can be involved too.

But if it is time to move Dad (& it sounds like it is) may you be at peace with the decision. Hopefully he is one that will benefit from a regular diet, medication management & socialisation. I hope some of the replies have given you some ideas. Maybe you feel a little less alone hearing others stories?

I wish you all the best. Keep writing if it helps.

You have guardianship? Then you are in charge. He does not have to go willingly if it comes to that. But perhaps he is tired of living, just wants to do whatever and let it all go...like, suicide on the installment plan. Not everyone wants to live into extreme old age. If dad is an acute danger to self, or a danger to others, then you can use your guardianship powers to move him.

After my Dad had a stroke he spent the next 5 years sitting in the kitchen watching television waiting to die. He refused any help with his medications which drove my mother, a retired RN, crazy. I finally told her let him, that is the only thing in his life he has control over.

What is the most important thing for your dad to change? Can you focus on one topic and see if it can be fixed with your dad's cooperation. I would guess that his world is spinning out of his control with so many people wanting him to change what he has always done.

Sounds like the food is the main thing to address first. Perhaps consult a dietitian to work out some healthier options that will balance out the vitamin/mineral issues that are driving his sweet tooth.

We contracted with a Home Health service that would administer meds if needed, and cooked healthy meals they both liked. It took a few tries to get aids that Dad cooperated with. I left it up to my parents to decide which ones they would let into the house.

Have you discussed how other residents were moved there? I cant believe the care manager cant come up with any ideas. Or what worked with others. They see this almost DAILY! Maybe she isn't forthcoming bc they dont want a combative or belligerent person. They will make him leave in short order if hes giving staff a hard time. You can read about it on this forum. They dont want problems.
I would get any snacks out of the house. Lock in basement. Or in a chest in basement/room. Tell care workers no food is to be brought in, no exception! Even if they treat. Tell them you will hold them responsible when his blood sugars are sky hi and he goes into a diabetic coma. Or he's gained too much weight and cant have it.. You will dole it out. Or leave what he can have on counter, no more. They might think they are being nice to an old man, doing him a favor.

As for meds chat with doc and see if it can be crushed up in pudding, applesauce, smoothy or changed to liquid to hide better. They know about ways to hide meds. Maybe offer small snacks instead to keep him happy. If he demands more, money is tight. Big bill came in. Stores out due to covid. He ate it all yesterday. Whatever it takes. Smaller portion snacks might keep him happy and not complaining. If he demands ice cream get the kiddie cups. Get a cheap cabinet and keep it locked or in locked room/basement. Or the snack packs of small lunch chips.
Id talk to doc to see if meds can be changed to a liquid and hidden in food or what can be crushed. That way he never sees it. He sees pudding!!!yeah!
Id see if doc can get him some med where he's not so belligerent. Tell him/her that you and care givers can not handle these moods any more. Does he have depression? Depression can be turned inward or outward onto other people. It is very common in elderly.
Gold luck.

As others said, multiple issues at hand.

Typical caregivers can't dispense medication. They can remind, suggest, point it out, etc - best if in a locked and timed dispenser. In his case, there is resistance to taking them. Aides who are familiar with dementia should know how to coax someone to take meds/do things they are resistant to. Somehow make it THEIR decision. The same issue will likely happen in MC too.

Them allowing him to eat and even providing the ice cream bars is a disgrace! Sure, you want to keep him happy, but it isn't good for his overall health! Not getting medication, overdoing the sugar - yikes! My mother LOVES the ice cream bars they have at MC. She eats most of the food, but managed to gain 20 lbs in the first year (she was already overweight) from that and sitting too much.

Forcing a move - despite what others say/think, POAs are insufficient for making someone move, but you have guardianship. Obviously you have the "power" to make the move happen, but it is the actual moving that is the issue. He is going to be aggressively resistant. He's refusing to move and there are limited ways to make that happen!

THAT puts a damper on things. Our mother was totally against considering moving anywhere, esp not AL (although it had been in her plans before dementia!) In her case, she managed to injure her leg, develop cellulitis, just prior to the move. After initial ER/treatment, YB drafted a letter, supposedly from 'Elder Services' at the hospital, telling her she either moves to a place we choose, or they will move her. My brothers were able to move her then (I stayed out of the actual move, just did all the prep work.) However, she was not a large aggressive younger man!

About calling ambulance:
IF he refuses to go with them, they are not likely going to force him. You could ask them first what they do in a situation like this, but EMTs wanted to take mom to ER after a stroke at MC recently. Nope. They called me to get okay to take her, but as I said, even if I agree, you are still taking her against her wishes! My last word was if YOU can talk her into going, fine, but no hospitalization. She refused. Even with dementia, they CAN'T force anyone to do what they are refusing.

Note from https://www.agingcare.com/articles/legally-force-move-to-assisted-living-155888.htm

"The legal system so respects each individual’s right to make decisions about their life that, if a cognitively impaired adult has moments of lucidity and can state that they want to remain at home, the judge will usually rule that they can do so and then order the appointed guardian to establish appropriate systems, such as in-home care and home modifications, to ensure their safety and wellbeing.
Why do the courts take this stance? Geffen explains it is in line with a 1999 U.S. Supreme Court decision that ruled unnecessary “institutionalization” of people with disabilities is a type of discrimination prohibited by the Americans with Disabilities Act (ADA). According to Geffen, this decision has become shorthand for the principle that institutionalization (which includes senior living settings like assisted living and nursing homes) should be a last resort for people who need long-term care services and supports."

I would suggest medication (Note: I am NOT a fan of medication, but sometimes it is a necessary evil!) Working with his docs may come up with something that works, to calm him down without doping him, but then you have the issue of him not taking his medications. I would have a long talk with the right docs about this! I've read others suggesting Baker Act, and see that it is a law in your state. Perhaps this can be used to get him into "detention", so they can work on getting the medication right, then move him from there to MC. He will likely have to continue taking medication(s) for this issue. Although it makes it hard on the resident and family, they have to protect their other residents and staff from those who are violent.

AmiRMP: I am so sorry that paranoia has taken over your LO. Perhaps a visit to a geriatrician can help with his sugar issue. Prayers sent.

Boy, lots of issues. My response addresses the sugar craving first. I am not in the medical field, but do a lot of research.
Sugar cravings can be due to mineral deficiencies. Low zinc, chromium, calcium and magnesium can cause sugar cravings.
My reading suggests changing the diet to include protein at each meal and include more beans and legumes. Also, more hydration which is a battle for most seniors. What does your dad like to drink besides sugary drinks? I often mix half lemonade and water, also I give my Mom soup for lunch

Natural sugars in fruits especially berries is helpful.
It also sounds like your dad is depressed, which can be caused by too much sugar. Also, does anyone have meals with your dad?
Can you or siblings join dad for dinner or lunch several times a week? Do the caregivers eat with him? Eating alone can be very depressing .
When medical issues are dealt with, you may see changes in your dad. He may once again want to walk the beach. I suggest that someone walk with him.
Hopefully, my rambling thoughts will help you and your dad.

Dear Ami; This must be a heart-breaking time for you. You want to do what's best for your dad, but you also want to keep him (and others, like pedestrians) safe. And since you have guardianship, you are totally responsible for him.

Are you legally and financially responsible if he manages to get to his car, drives it and kills or maims someone? Do you have enough insurance to cover that eventuality?

Have you consulted a geriatric psychiatrist about medications that might ease the paranoia?

When I read this two thing came to mind. 1. He is still somewhat there and is choosing this lifestyle to hopefully kill him before he loses all his memory. (because of the mass quantity of sugary foods). 2. He has lost judgement and reasoning cognitive abilities. So his decisions make sense to him. Either way he needs help. He might fight you because he is depressed. The lack of interest with visitors, lack of taking care of yourself and gaining weight are all signs of depression. When my mom was going through this I came right out and asked her why she eats like crap, she also gained 20 pounds. She said she doesn't want to be an old lady. I said who does!! lol she started to cry and I let her. What I'm trying to say is have a different talk with your dad. Come right out and ask him are you doing all this to yourself because you are trying to die? If he says yes then he needs to be seen by a doctor as soon as possible. If he says no then tell him if he keeps up this behavior he will be dead soon and explain to him his lab results. Sometimes we treat our parents as children because of their behavior but they still want to be part of the decision process so by doing this it makes them feel they are part of it. It worked for my mom. She chose to not see a doctor and not be put on meds for depression instead to accept that this was her new norm and she has to accept it. You may be able to get a social worker in to speak to him because rage can be frustration he is experiencing and sometimes they know how to handle it or can help you get him to a place like memory care facility. Good Luck

You've been trying reasoning and logic, and that never works with someone who has dementia.

The folks who run my mother's memory care often advise using the excuse that the house has termites and needs to be tented as the way to get a reluctant LO out of the house. The LO has to be out of the house for a solid five days for a termite tenting, the house is full of deadly poison, so there's no sneaking back before that time is up, and by the end of that week, the LO tends to be settling in to the new surroundings a bit better.

Of course, no houses are actually being tented or filled with deadly poison, but I remember the director of the place saying they've "tented" more homes than you can imagine. If you live someplace where termites aren't a good excuse, try to come up with some other catastrophic excuse to get him out of the house. If you've chosen a facility, they should be able to work with you on a way to get him there.

There may still be more of a working mind than he is given credit for. For now, you might try to control the food that's in his house.
-A caregiver should not be going out to get him ice cream sandwiches when the sugar levels (documented) are getting higher all the time. They can, however, prepare things that are a little healthier and have them ready in frig or hand them to him at meal time. Salads w/frozen grilled chicken, small meal containers prepared ahead of time/frozen and set out daily, soups frozen/set out certain days, etc. If he prefers to sit around, he will probably take the path of least resistance when hungry, so meal prep might help.
-He may need to adjust his sugar meds based on the recent test. Talk to dr about that. My parent took glipizide as needed, but when the test results showed increase in numbers - I added 1/2 pill to lunch time (every day) and have seen a difference. For snack, I have nuts and peanut butter pretzels that I dole out or popcorn and it seems to squash the hunger, (I'm a chocoholic, so I understand your dad's chocolate thing. Mini sized candies help.)
-How does he get a 28oz size of pudding? Order some dietetic puddings in the small cups. Same for the yogurt - look for brands with minimal sugars and maybe add granola or fruits to it. There are also some ice creams with minimal sugars. Do online grocery orders and pay attention to sugar coming into the house. Put extra supplies of these things in a special place he is unlikely to search to have more control over what he spots to eat when he's hungry.
-His meds can be ordered online in packets to be taken at certain times. Maybe an alarm on his phone to remind him it's time. Or the caregivers can hand him packet at appropriate time and watch him take the pills. It's very possible he gets them out, puts them down to do something and then forgets about it.
-Ask dr for phys/occ therapy to see if they can get him moving a little. It can't hurt to try.

You say he refuses to do things to make his life more pleasurable. Not entirely true. Eating, watching tv, laying around are probably his pleasures now. So, if there's anyway to control the eating/what is available to eat, it may help him.

At some point, his brain is not going to be even what it is now and a move might be more doable with the therapeutic lie. Since you already have caregivers helping him, have a chat with them about what is NOT working right now and give it another shot to try a better way. It can't hurt.

I went through something similar with my mom this past August. I told her that her primary doctor wants her to try out memory care because he thinks that will really help her! She'll get exercise, good food, they have memory exercises, and it will be just for awhile to see if her mind improves. The night before, while she was at my house, we went to her house and got all her stuff packed. The movers came and picked up all she needed for her apartment. The next day, the facility called us when her apartment was ready. My brother, not me cuz I would have cried too much, dropped her off. They met her at the door and escorted her in to the building. She has good days and bad days. She still wants to go home all the time. However, in the mornings, she like her coffee time with the other residents. She wouldn't have that home by herself. She gained weight because the food is good! The staff say she sings alot, which means she has some joy. I realized that even if she was living with me, she would still want to go home, have sad days, and would be fighting me instead of the staff. The staff are trained to deal with dementia. I investigated a few top rated facilities before we chose one for her. Is there someone your dad trusts? My mom thinks her primary care doctor is wonderful, so we used that to get her in. Would your dad have someone like that you could use? It's tough! I pray you find a way.

My sister and I wanted our father to go into an assisted living facility two years ago, but Dad refused and wanted to stay in his home as long as possible. He was put on hospice in September and had two falls at home that allowed us to convince Dad that he needed 24/7 care that he could not get at home by himself. He reluctantly agreed. Understand that at this point my father's life/existence is limited to sitting in a chair 24/7. He only gets out of the chair to sit on the porta-potty next to the chair. He eats in the chair, sleeps in the chair, watches tv in the chair... his mental decline has him believing that he is in his living room at home even though he is in a nursing facility. And he has the round the clock care that he needs, for however long he has left... My sister and I are sad that it had to come to this, but we are relieved knowing he is being fed, bathed, given his meds, etc... on a regular schedule.

I am so sorry that your LO is so stubborn. These kind of clients are usually the reason memory care and total care facilities exist. Home health care aides can not "give medications" but they can "remind" their clients to take their medications. Nurses are allowed to give medications to patients and that is why there are LPNs in memory care and total care facilities.

Since your LO is paranoid and totally noncompliant with his care, he may need some time in an inpatient psychiatric unit. Please get him in to see his doctor for an evaluation and maybe a psychiatric consult. His doctors can advise you on next steps in compliance with the law where you live.

Maybe your father would do all right living separate from you with 24-hour male caregivers. If he still has it together well enough to all for an uber and return to his old home, then I'm thinking he might not be as out of it as you think. Also, all these sweets he's craving and wanting come in sugar-free varieties. He may need to be on different medications. You do say he won't take his meds, but they may come in liquid form or be crushable and can be put in his food. These alternatives might help instead of having him physically removed by ambulance and put into a nursing home.

We had a family member (sort of) like this. Refused to admit he needed help for his physical and mental decline. Refused caregivers. A diabetic for decades, he ate massive amounts of sugary food and then "treated" himself with big shots of insulin.

He eventually passed out, fell, was transported to the hospital and then they took care of a safe discharge to a facility.

We were lucky in that he is not causing trouble at the facility. I hope other people can advise you on strategies to handle that problem.

At my wife's children suggestion I placed my wife in a memory care facility. The first day she got into a fight with another resident, the next day she swung at another person. The facility kicked her out that day. I interviewed many facilities prior to placing her. The facility told me to expect issues at first but that they knew how to handle any issues. What I'm saying is don't believe everything you hear from the facility. I don't know how to check out their records only saying be careful. As for me I have hired a caregiver through an agency that comes in 9 hours a day 7 days a week. It is cheaper than a memory care facility and she has excellent care at home. I'm at peace with the care she is getting and I'm able to have a relatively good life. Best wishes for you as you go through your ordeal.

If you have Guardianship that is all you need to move him into Memory Care.
You have been granted Guardianship because the doctor(s) and the Court felt that he was/is unable to make rational, cognitive decisions on his own. For his safety and best welfare they granted you the responsibility to make these decisions for him keeping his safety and best interest in mind.

I am so sorry you are going through this. Unfortunately I had to wait for a significant physical decline and two hospitalizations before I could place my mother in a facility with memory care. But her overall behavior hasn’t changed. She doesn’t participate in any pleasurable activities, refuses to leave her room, is rude, swats at the staff, curses, and wants to go back home although she is completely dependent upon staff to bathe her, feed her, etc. she still won’t eat well and calls people to tell them she is being beaten, poisoned, and so on.

I guess the lesson I learned was that I was never going to improve my mother’s life - I was only going to be tasked with the very unpleasant and stressful job of keeping her safe. But if she wants to stay in her room, curse at people, eat poorly, refuse her medications and not comply with doctors request for elevating her legs, then I can’t change that. Her personality hasn’t changed in her dementia. I chose a lovely facility with all kinds of activities and views of the mountains and she’s still as miserable as she always was. The difference is the staff in memory care know how to deal with her behavior. I’ve been able to work with her doctor to get some medication for her anxiety and depression.

Good luck and keep us posted!

My mother has been living with me for nearly a year. She also is in denial of her mental and physical health. She is mean and aggressive to the point she even tried to hit me the other day. I found a retirement community for her with independent living that also has AL and Nursing if needed. She 100% refuses to go. I FEEL sorry for her still. But her presence in my life is killing me. I had a stroke 2 months ago. Way too much stress for me. I can no longer suffer in her reality. She has decided to move and all of it seems crazy to me. But I do not wish to die by trying to keep her safe and sound. I am choosing the rout of letting her go. And letting her live with the consequences of her own actions. I was going to go the rout of having her declared incompetent and the court battle and then decided if it was that attempted to make her life easier as she grew older and as you stated,” wanting a more pleasurable life for your dad” then this was not the rout to be taken. What will be will be, it was never really in my control to have her have a better aging experience. They are sick and they don’t get it. Nothing you do will change their outcome. Thanks for being a good human and trying to do what’s best for your dad. He is young to be experiencing this and my heart goes out to you both. You have created some tough decisions for yourself. I wish you peace along the rout.

When my Mother refused to even consider Memory Care, I waited until she fell and went to the hospital. The Doctor there said to transport her from the hospital directly to Memory Care. That worked !! Now I have 24/7 piece of mind that she is eating well and if she falls, someone will find her in two hours or less.

How heartbreaking for you and for him.

In your situation I’d opt for medication. My LO was EXTREMELY DIFFICULT, and as it happened there was a truly amazing psychiatric practice associated with the MC unit. LO had already been on an antidepressant, and with a few additions and adjustments in her medical regime, she began to improve, and before Covid was doing well. She still enjoys are distanced visits and accepts the care she’s receiving.

If our initial effort hadn’t been successful I would definitely have attempted to seek the opinion of another specialist, or a third, until I found something that helped.

You have done all the right things already, and I can’t think of a single thing else to try. I’d guess that you’re considering the fact that your dad might be over medicated during the process, and again, going from my own experience I’d be very clear that your goal would be a safe, supportive situation for him, so that you’d want the medication introduced in small doses to see what might actually work and what wouldn’t.

”Rage” and dangerously denying the welfare of yourself and those who are caring for you are serious symptoms and need to be dealt with as emergencies, and I’m sure you already know what I mean only too well.

Hoping that something can be found that can help you both through this very difficult transition.

You say that your Dad doesn't believe he has Dementia. Yet you have guardianship. So what are the facts here.
Has your Dad been diagnosed with dementia? Did your Dad fight the guardianship, have full representation under law, and you have now for some time acted as his guardian?
Has your father had full physical exam when he went into "paranoia"? Do you have a doctor for him, and a full diagnosis of dementia?
If so that is pretty much that. The way you move Dad is, as the old expression says, "Lock, Stock and Barrel". You choose the facility that will accept him and you call the ambulance service (not 911 but a call) and have the papers for admission ready, and you have Dad transported to his new home.
Sorry for all you are going through. You have taken on an unimaginably tough job.

There is a medical term for people who don't recognize their illness: "anosognosia", when someone is unaware of their own mental health condition or that they can't perceive their condition accurately.

Please be aware that even if you were able to trick him into a MC facility, he may act out to the point where the can be kicked out. Make sure you understand the policies and abilities of whatever facilities you are considering for him. Ask them for ideas on how they would get him there, as they have seen it all.

"...he is refusing to do anything that would make his life more pleasurable". Pleasurable is a relative thing now. I had this same hope/expectation for my MIL when I worked for a year and half to solve her financial and aging care problems and get her into a wonderful, small facility while on Medicaid. She got there and refused to get out of bed, not even for meals. That was in 2017 and she still won't get out of bed. Now she can't because all her leg muscles have atrophied and she's too heavy. It is what it is. I hope you/your family are not footing the bill for his in-home care.

I would maybe work through a caregiving agency and make sure they send people who know to not feed him foods that add to his problems. The caregivers need to make sure he is taking his meds -- watching him put it in his mouth and swallow it.

In the end you will only be able to do what you are able to do and that will be morally and ethically acceptable. Your father's paranoia may be part of his Parkinsons, (Lewy Body Syndrome). It's a ton of daily management, and I can only imagine your stress (and many on this forum have lived through it). I wish you success in carrying out a care plan that works for him and you both.

Your his guardian. You do what is in his best interest. If that means a Memory care unit, so be it. No lie, just do it. The problem I do see is if he gets aggressive. Memory care wil, not keep him.